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Cushing's disease
Cushing's disease, also called hyperadrenocorticism, is a malfunction of the adrenal glands or the anterior portion of the pituitary gland causing overproduction of the hormone cortisol. One of the normal functions of cortisol is to raise blood sugar, and so the high cortisol levels keep blood glucose levels at continual high levels, causing a form of secondary diabetes. Like anything that causes prolonged hyperglycemia, one of the side effects over time can be permanent diabetes. Some causes of Cushing's are pituitary or adrenal gland tumors and overuse of glucocortcoid steroids. Because of the hyperglycemia Cushing's creates, it's possible (but not frequent) to find ketones in the urine. When dealing with concurrent conditions of both Cushing's and diabetes mellitus, the diabetes needs to be under some sort of control and any ketone problems resolved before testing for Cushing's Disease can be done. Testing done for the disease until a ketoacidosis episode has passed will result in false positive reports. These tests can't be run until a minimum of 2 weeks after a ketoacidosis episode to receive valid results. page 3 Another disorder of the adrenal gland causes it to produce less than normal cortisol. It is known as Addison's disease and is the direct opposite of Cushing's disease. Pituitary or Adrenal Cause? Cushing's Disease in Dogs. The pituitary gland is divided into 2 sections-posterior and anterior. It's the anterior portion that produces adrenocorticotropic hormone, also known as ACTH, which controls the amount of cortisol the adrenal gland produces. Tumors of the pituitary gland upset the natural balance of its ability to sense when there's enough cortisol in the body so it keeps producing the hormone which tells the adrenal gland that more cortisol is needed. . Because the pituitary gland erroneously continues to produce adrenal-stimulating hormone, the adrenal gland continues to respond to it and produces more cortisol than is necessary to the system The "root" cause of this type of Cushing's Disease is actually the malfunction of the anterior pituitary. It is known as pituitary-dependent Cushing's because the Cushing's exists due to the pituitary's overproduction of the adrenal-stimulating hormone. This is the most common (85%) cause of Cushing's Disease. In adrenal-dependent Cushing's, a tumor in the adrenal gland is responsible for the cortisol over-production. Adrenal-dependent Cushing's accounts for 15% of diagnosed cases. The distinction between them is important because the manner of treatment protocol can vary substantially. Cushing's/diabetes connection tnfiO7y4UeQ Cushing's Disease-Pet Doctors of America. The basic connection between Cushing's and diabetes is this: the excess cortisol produced by the faulty adrenal gland is a signal for the body to produce new, non-sugar sourced glucose (Gluconeogenesis). When this additional glucose reaches the bloodstream, another signal goes off; this one to the endocrine pancreas to produce more insulin to handle the glucose present in the blood. When the insulin production ability of the pancreas can no longer keep up with the additional blood glucose which the excess cortisol from the malfunctioning adrenal gland keeps emitting, the islet cells of the endocrine pancreas are exhausted, and diabetes results. In effect, the overproductive adrenal gland has the capability to "burn out" the insulin producing capability of the pancreas. If the islet cells of the pancreas are still able to produce sufficient endogenous insulin for the body's needs, controlling the Cushing's will also control the blood glucose, meaning there would be no need for insulin injections. If the pancreas' islet cells have sustained such damage as to be unable to produce enough insulin for the body, insulin shots are necessary. Most cases of diabetes and Cushing's begin as Cushing's disease alone. For dogs with both Cushing's and diabetes, the key to starting or maintaining regulation is effective control of the Cushing's. Ending the excess of cortisol production allows the diabetes to be managed. In cases where Cushing's is the primary condition, causing transient, or secondary diabetes, it may be possible to return to non-diabetic status with successful management of Cushing's. About 80% of cats and 10% of dogs with Cushing's are diabetic. In dogs, breeds such as Boston Terriers, German Shepherds, Poodles, Boxers, Dachshunds and Scotties, seem to be genetically predisposed to Cushing's Disease. This is to say that it is most commonly diagnosed in dogs of the breeds above; any dog can be diagnosed with Cushing's regardless of his/her breed. Cushing's/Cortisone meds connection Like diabetes, Cushing's can be caused by over-use of Cortisone-type medications. Because the pituitary gland also acts as a sensor, it detects the high levels of cortisol in the body and does not signal the adrenal gland to produce more. The adrenal gland becomes inactive and can atrophy from disuse, much in the way non-used muscles do, losing the ability to function normally. Exogenous cortisone puts the adrenal gland into a sort-of hibernation. While they are being administered, they furnish the body's cortisol needs in addition to treating the condition they were prescribed for. The adrenal gland needs to be "awakened" from its rest gradually so it can begin full function once again. This is why cortisone and similar drug treatment is slowly and carefully withdrawn. Simply stopping the medication means leaving the body without sufficient cortisone--exogenous or endogenous. Canine cushing's Cases of Cushing's disease are relatively common in dogs but less so in cats. These are common symptoms in dogs: Pets with Cushing's often do not heal as quickly regarding surgeries or injuries. It is also possible for pets to develop forms of neuropathy from Cushing's, since it is considered an endocrine disease. And, as with diabetes mellitus, Cushing's can cause polydipsia and polyuria, making it sometimes difficult to determine what the real problem is. Another health problem for canine Cushing's patients is high blood pressure (hypertension). A 1996 JAVMA study found 86% of study dogs with Cushing's to be suffering from hypertension. It also found that 40% of them continued having high blood pressure after effective management of the Cushing's. Dogs with Cushing's are, like those with diabetes, prone to Urinary tract infections. With both diseases, the infections can be hidden, thus not producing any signs of them. Urine cultures are recommended for both Cushing's and diabetes patients because of lack of symptoms. . Like dogs with diabetes mellitus and hypothyroidism, dogs with Cushing's are at an increased risk of acute pancreatitis The over-production of cortisol in Cushing's disease increases calcium excretion in the urine. This in turn can form into calcium oxalate bladder stones. Dogs with Cushing's, diabetes, or hypothyroidism have a tendency to have less than normal tear production. . The permanent lack of enough lubrication can lead to dry eye. They are also at risk for other eye-related disorders as a result of the Cushing's. Treatment Depending on what's causing the Cushing's, treatment can range from surgery (in some tumor cases) to courses of treatment with Lysodren (the generic name for Lysodren is mitotane), Ketaconazole, Anipryl or Trilostane, all of which are described at the link below. There is sometimes the medical need to either remove or destroy the adrenal glands through medication. This causes Addison's disease--a lack of enough cortisol, and means replacement cortisone medication must be taken for life. Trilostane, known as Vetoryl when dispensed for veterinary purposes, and Modrenal, Desopan or Modrastane when prescribed for people, is the only approved treatment for Cushing's in the UK. Vetoryl is now approved for use in the US. Dechra Press Release-US Approval of Vetoryl These FDA letters, dated September 11, 2009, indicate that the only approved US source of trilostane is the Dechra product and further state that should compounding to obtain the proper strength for the patient be necessary, only the Dechra Vetoryl may be used for that purpose. Here's help-message boards and e-mail lists *Canine Cushing's Message Board where help and support are available. *CanineCushings-AutoimmuneCare CanineCushings-AutoimmuneCare is an educational support group with an extensive collection of resources and information. *Texas A & M Cushing's in Pets Mailing List & Mailing List Archives Very informative on all types of treatment for Cushing's. References More Information *Cushings Disease Information website by Dechra *Pet Owner's Crash Course in Canine Cushing's Disease Kate Connick *Cushing's Syndrome Information Website MarVista Vet * Canine Cushing's Tests Cambridge Specialist Laboratory Services-UK *The Story of Jack, a 14 year old UK canine with Cushing's using Vetoryl (trilostane) Brown, Stuart. Other treatment methods are discussed and some helpful links. *Trilostane treatment in dogs with pituitary-dependent hyperadrenocorticism page 598 (18 of 56) JA Braddock, DB Church, ID Robertson and ADJ Watson, 2003, Australian Veterinary Journal. The study compares Trilostane treatment to Lysodren (mitotane). *Twice-Daily Trilostane For Cushing's TreatmentCarolina Arenas Bermejo, Carlos Melian Liminana, Dolores Perez Alenza, 2002, WSAVA *Trilostane Treatment in Canine Cushing's Syndrome Dixon, Richard, Axiom Vet Laboratories UK *Canine Hyperadrenocorticism, Diabetes Mellitus, or Both? Kirsten Zwicker, DVM; Perry J. Bain, DVM, PhD; Pauline M. Rakich, DVM, PhD; Kenneth S. Latimer, DVM, PhD, University of Georgia A Clinical Guide to Differentiating Between These Diseases: They Share Some Common Symptoms *Adrenal Function Tests--Use in Dogs Schermerhorn, Thomas, 2005, WSAVA *Hyperadrenocorticism: Choosing the Right Diagnostic Tests Mooney, Carmel T., 2003, WSAVA *Canine Cushing's Disease-Treatment Options Nelson, Richard, 2003, WSAVA *Muscle Cramps in 2 Standard Poodles With Cushing'sMiyoko Saito, DVM, Natasha J. Olby, Vet, MB, PhD, Diplomate ACVIM (Neurology), Leticia Obledo, DVM and Jody L. Gookin, DVM, PhD, Diplomate ACVIM, 2002, JAAHA *Myotonia Associated With Hyperadrenocorticism in Two Dogs Swinney GR, Foster SF, Church DB, Malik R., 1998, Australian Veterinary Journal *Canine Cushing's Treatment Options Reusch, Claudia, 2002, WSAVA *Study of the Effects of Once Daily Doses of Trilostane on Cortisol Concentrations and Responsiveness to Adrenocorticotrophic Hormone in Hyperadrenocorticoid Dogs Bell R, Neiger R, McGrotty Y, Ramsey IK., 2006, The Veterinary Record *A Comparison of the Survival Times of Dogs Treated with Mitotane (Lysodren) or Trilostane for Pituitary-dependent Hyperadrenocorticism Barker EN, Campbell S, Tebb AJ, Neiger R, Herrtage ME, Reid SW, Ramsey IK., 2005, Journal of Veterinary Internal Medicine *Adrenal Necrosis in a Dog Receiving Trilostane for the Treatment of HyperadrenocorticismChapman PS, Kelly DF, Archer J, Brockman DJ, Neiger R., 2004, Journal of Small Animal Practice *Introduction to Canine Hyperadrenocorticism (Cushing's Disease)Dixon, Richard, Axiom Vet Laboratories UK *Increased Parathyroid Hormone Concentrations in Dogs with HyperadrenocorticismI.K. Ramsey; A. Tebb; Y.McGrotty; E. Harris; H. Evans; M.E Herrtage, 2003, WSAVA *Trilostane vs Mitotane (Lysodren) in Cushing's North American Veterinary Conference-2006 *Trilostane Effectiveness in Hyperadrenocorticism (Cushing's) North American Veterinary Conference-2006 *Trilostane-5 Years of Clinical Experience/Cushing's Disease-Page 17 Reusch, Claudia, 2006, Ohio State University Endocrinology Symposium *Diagnosis & Therapy for Hyperadrenocorticism in the Dog-page 2 Neiger, Reto, 2005, IVIS *Cushing's Disease Pet Education.com-Drs. Foster & Smith *Myotonia=Amyotonia Dorland's Medical Dictionary *Atony Dorland's Medical Dictionary *Gastrointestinal Signs in Endocrine Disorders-Dogs & Cats Provet UK *Canine & Feline Cushing's Moore Vet *Cushing's Treatments Newman Veterinary An excellent overview of all methods & medications for treatment of Cushing's. *Endocrine Diseases in Dogs and Cats: Similarities and Differences with Endocrine Diseases in Humans Rijnberk A, Kooistra HS, Mol JA., 2003, Growth Hormone & IGF Research *Diagnosing Hyperadrenocorticism Bruyette, David, 2001, WSAVA *Diagnostic Testing for Hyperadrenocorticism Herrtage, Michael, 2002, WSAVA *Treatments for Pituitary Cushing's Diease Brooks, Wendy C., Veterinary Partner *Medical management of pituitary-dependent hyperadrenocorticism: mitotane versus trilostane Reine NJ., 2007, Clinical Tech-Small Animal Practice *Basal Cortisol Concentrations for Assessing Adrenal Function Antech Diagnostics *Cushing's Disease Long Beach Animal Hospital *Advances in the Diagnosis and Management of Canine HyperadrenocorticismDi Marco, Viviani, 2009, WSAVA *Evaluation of the Efficacy of Trilostane in the Treatment of Canine Hyperadrenocorticism: Retrospective Analysis of 17 Cases A.M. Vargas; A.L.S. Santos; V.U. Fonseca, 2009, WSAVA *Cushing's Controversies Graves, Thomas K., April 2009, DVM 360 *Cushing's Disease Complicated With Thrombosis in a Dog Teshama, Takahiro, et. al., 2007, Japan Veterinary Medical Society *Urinary Incontinence in the Dog PetsHealth *Underdiagnosis of Cushing's Due to Non-Textbook Signs? Ferguson, Duncan, Bruyette, David, DVM Veterinary Forum *Cushing's Disease in Dogs Dr. Ron Hines *Vetsulin-Diabetes-Related Diseases Intervet *Trilostane--A Review of a Success Story Reusch, Claudia, 2010, WSAVA *The Diagnostic Approach to Polyuria in the Dog Kooistra, Hans S., 2010,WSAVA *Endocrine Emergencies Wallace, Melissa S., 2001, Atlantic Coast Veterinary Conference *Ocular Manifestations of Systemic Disease in Small Animals Dennis E. Brooks, University of Florida School of Veterinary Medicine Category:Conditions Category:Complications Category:Other conditions and procedures Category:Content